SOUTHERN ILLINOIS RESPIRATORY DISEASE CONSULTANTS, LLC - NPI NUMBER 1124282462

Summary

Provider Name: SOUTHERN ILLINOIS RESPIRATORY DISEASE CONSULTANTS, LLC

NPI Number: 1124282462

Clasification: Internal Medicine (207RP1001X)

Specialization: Pulmonary Disease

Address:
317 S 14TH ST
SUITE 3
HERRIN, IL
ZIP 62948

Phone Number: (618) 942-7402



Detailed Information

SOUTHERN ILLINOIS RESPIRATORY DISEASE CONSULTANTS, LLC is a pulmonary disease internist in Herrin, IL. The provider is an internist who treats diseases of the lungs and airways. The pulmonologist diagnoses and treats cancer, pneumonia, pleurisy, asthma, occupational and environmental diseases, bronchitis, sleep disorders, emphysema and other complex disorders of the lungs. The assigned NPI number for this provider is 1124282462 and is registered as an organization entity type and is a single specialty group.

The provider's business address is:

317 S 14TH ST
SUITE 3
HERRIN, IL
ZIP 62948-671
Phone: (618) 942-7402

The provider's authorized official is Suhail Istanbouly .
The authorized official title is President and has the following contact phone number (618) 942-7402.

The enumeration date for this NPI number is 7/16/2008 and was last updated on 11/4/2008.

Map - Location of Practice

Similar Providers

NPI Provider Name / Taxonomy
1073826269 SAREER ZIA, MD
Internal Medicine
1144395633 A PRAMOTE MD SC
Internal Medicine
1144517996 SIVA PARCHA, MD
Internal Medicine
1144407131 SHAWNEE HEALTH SERVICE AND DEVELOPMENT CORPORATION
Internal Medicine (Pulmonary Disease)
1184822371 DR. SHANNON HOPEN, D.O.
Internal Medicine
1437163367 SOUTHERN ILLINOIS RHEUMATOLOGY, SC
Internal Medicine (Rheumatology)
1396775581 SHAWNEE HEALTH SERVICE DEVELOPMENT CORP
Internal Medicine (Pulmonary Disease)

Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 207RP1001X Internal Medicine Pulmonary Disease 036098950 IL Yes

Other (Legacy) Identifiers

The following legacy identifiers are available for this provider:

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1 217038 MEDICARE PIN IL
2 036098950 MEDICAID IL

NPI Record

No. Field Name Field Value
1 NPI 1124282462
2 Entity Type Code 2
3 Employer Identification Number EIN
4 Provider Organization Name Legal Business Name SOUTHERN ILLINOIS RESPIRATORY DISEASE CONSULTANTS, LLC
5 Provider First Line Business Practice Location Address 317 S 14TH ST
6 Provider Second Line Business Practice Location Address SUITE 3
7 Provider Business Practice Location Address City Name HERRIN
8 Provider Business Practice Location Address State Name IL
9 Provider Business Practice Location Address Postal Code 629483671
10 Provider Business Practice Location Address Country Code If outside U S US
11 Provider Business Practice Location Address Telephone Number 6189427402
12 Provider Enumeration Date 7/16/2008
13 Last Update Date 11/4/2008
14 Authorized Official Last Name ISTANBOULY
15 Authorized Official First Name SUHAIL
16 Authorized Official Title or Position PRESIDENT
17 Authorized Official Telephone Number 6189427402
18 Healthcare Provider Taxonomy Code 1 207RP1001X
19 Provider License Number 1 036098950
20 Provider License Number State Code 1 IL
21 Healthcare Provider Primary Taxonomy Switch 1 Y
22 Other Provider Identifier 1 217038
23 Other Provider Identifier Type Code 1 08
24 Other Provider Identifier State 1 IL
25 Other Provider Identifier 2 036098950
26 Other Provider Identifier Type Code 2 05
27 Other Provider Identifier State 2 IL
28 Is Organization Subpart N
29 Authorized Official Name Prefix Text DR.
30 Authorized Official Credential Text M.D.
31 Healthcare Provider Taxonomy Group 1 193400000X SINGLE SPECIALTY GROUP

Download Record

Download this NPI record in Text format: Export

Download this NPI record in Excel (CSV) format: Export

Download this NPI record in XML format: Export




This page was last updated on: 7/15/2014
All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.